Provider Demographics
NPI:1871563163
Name:BRANDWINE, WARREN I (DO)
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:I
Last Name:BRANDWINE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-0536
Mailing Address - Country:US
Mailing Address - Phone:856-669-6050
Mailing Address - Fax:856-651-0794
Practice Address - Street 1:150 CENTURY PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1129
Practice Address - Country:US
Practice Address - Phone:856-778-1881
Practice Address - Fax:856-778-1572
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB032448207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD06846Medicare UPIN
NJ102273N5XMedicare PIN